Separating oral burning from burning mouth syndrome: unravelling a diagnostic enigma

Abstract Background: Vestibular schwannoma (VS) or acoustic neuroma is a benign brain tumor. Despite improvements in surgical technique, the removal of VS is related to some complications of which the recovery is difficult and sometimes lead to permanent deficits. About 10.7% of complication of vestibular schwannoma surgery is reported to affect facial or tongue area, including numbness of pain, which is similar to a typical symptom of burning mouth syndrome (BMS). However, up to our knowledge, there is no documented case of BMS either comorbid with vestibular schwannoma or occur due to surgery complications. Clinical Presentation: A 46-year-old woman complained about left-sided facial pain, a burning sensation on the left side of her tongue and maxilla, and a spontaneous bitter taste. Four years before her first visit to our clinic, left-sided facial pain and burning sensation on the left side of the tongue suddenly became severe. She visited a neurosurgeon and VS was found in the left cerebellopontine angle. After the tumor was removed, facial pain, burning sensation of the tongue, and bitter taste improved simultaneously but quickly recurred after a while. The patient had a panic attack because of severe pain and started visiting a psychiatrist. The psychiatrist diagnosed her as having somatic symptom disorder and depression, prescribing sertraline 100 mg, zolpidem 5 mg, and lorazepam 1.0 mg and referred her to our clinic. At the first visit, no abnormal intraoral nor extraoral findings were detected. Based on the characteristics of the pain, we made a diagnose of BMS. Amitriptyline was initiated at 10 mg/day and increased to 30 m. Within 1.5 months, the pain and burning sensation of the tongue and maxilla almost remitted completely, whereas bitter taste showed moderate improvement. Conclusions: Our case suggests there might be an exceptional case in which BMS and VS can occur simultaneously. Specifically, an oral burning sensation and dysgeusia after VS surgery are not always a case of surgical complication or untreatable.

Download Full-text

Burning Mouth Syndrome pada wanita Menopause dengan Hiposalivasi, Coated Tongue dan Gangguan Pengecapan serta Penatalaksanaannya

Majalah Kedokteran Gigi Indonesia ◽

10.22146/majkedgiind.15920 ◽

2012 ◽

Vol 19 (1) ◽

pp. 82

Author(s):

Sri Hadiati

Keyword(s):

Oral Cavity ◽

Postmenopausal Women ◽

Vitamin B1 ◽

Burning Mouth Syndrome ◽

Burning Sensation ◽

Chewing Gum ◽

Affected Patient ◽

Burning Mouth ◽

Oral Burning

Blackground: Burning mouth syndrome (BMS) is a disorder that is characterized by a burning sensation of the oral cavity in the absence of visible local or systemic abnormalities. Affected patient often present with multiple oral complaints, including burning, dryness and taste alterations. The exact cause of burning mouth syndrome often is difficult to pin point. Conditions that have been reported in association with burning mouth syndrome include menopause, hyposlivation, coated tongue, taste alterations and psychologic condition. Objective: To report a case of burning mouth syndrome in postmenopausal women with hyposalivation, coated tongue, taste alterations and psychologic condition and its management. Case and management: a case of burning mouth syndrome in women with menopause, hyposalivation, coated tongue, and taste alterations, was managed effectively by gabapentin 100mg, probiotic chewing gum, diazepam 2mg and vitamin B1, B6, B12. Conclusion: Oral burning appears to be most prevalent in postmenopausal women often present with multiple oral complaints, including burning, dryness and taste alterations, in this case was managed effectively by gabapentin 100mg, prebiotic chewing gum, diazepam 2mg and vitamin B1, B6, B12.

Download Full-text

Burning Mouth Syndrome and Secondary Oral Burning

Otolaryngologic Clinics of North America ◽

10.1016/j.otc.2010.09.008 ◽

2011 ◽

Vol 44 (1) ◽

pp. 205-219 ◽

Cited By ~ 17

Author(s):

Jacob S. Minor ◽

Joel B. Epstein

Keyword(s):

Burning Mouth Syndrome ◽

Burning Mouth ◽

Oral Burning

Download Full-text

Oral burning and burning mouth syndrome

The Journal of the American Dental Association ◽

10.14219/jada.archive.2012.0093 ◽

2012 ◽

Vol 143 (12) ◽

pp. 1317-1319 ◽

Cited By ~ 10

Author(s):

Gary D. Klasser ◽

Joel B. Epstein

Keyword(s):

Burning Mouth Syndrome ◽

Burning Mouth ◽

Oral Burning

Download Full-text

A case of vestibular schwannoma mimicking burning mouth syndrome

BioPsychoSocial Medicine ◽

10.1186/s13030-021-00209-y ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Takayuki Suga ◽

Miho Takenoshita ◽

Trang T. H. Tu ◽

Takashi Sugawara ◽

Susumu Kirimura ◽

...

Keyword(s):

Burning Mouth Syndrome ◽

Burning Sensation ◽

Careful Examination ◽

Taste Disturbance ◽

Chief Complaints ◽

Triggering Factor ◽

Psychosocial Conditions ◽

Burning Mouth ◽

The Right ◽

Oral Burning

Abstract Background An oral burning sensation with unidentified cause in patients with preexisting psychosocial conditions is usually diagnosed as burning mouth syndrome. However, unexpected organic lesions may be detected in rare cases. Case presentation A 35-year-old woman had chief complaints of a burning sensation and numbness of the right side of the lip and tongue, as well as a dry sensation of the mouth with a taste disturbance of the right side of the tongue. The symptoms were continuous and did not show any daily fluctuations. The symptoms started without any recognizable triggering factor six months before her first visit to our clinic,. No abnormality was detected in her mouth. MRI images revealed an approximately 30 × 30 mm well-defined mass localized in the right cerebropontine angle compressing the trigeminal nerve, which was diagnosed as schwannoma of the right auditory nerve. Conclusions It is important for clinicians to consider the possibility of brain tumors in their differential diagnosis of BMS. Although it is not always easy to eliminate all diseases that may cause an oral burning sensation in patients with BMS-like symptoms, more attention and careful examination based on the patient’s psychosomatic background features and other possible causes are needed to rule out organic diseases.

Download Full-text

Oral burning and burning mouth syndrome

Dental Nursing ◽

10.12968/denn.2011.7.10.554 ◽

2011 ◽

Vol 7 (10) ◽

pp. 554-559

Author(s):

Sabine Jurge

Keyword(s):

Burning Mouth Syndrome ◽

Burning Mouth ◽

Oral Burning

Download Full-text

Comparative Analysis of Psychological, Hormonal, and Genetic Factors Between Burning Mouth Syndrome and Secondary Oral Burning

Pain Medicine ◽

10.1093/pm/pnv087 ◽

2016 ◽

Vol 17 (9) ◽

pp. 1602-1611 ◽

Cited By ~ 13

Author(s):

Emeline das Neves de Araújo Lima ◽

Natália Guimarães Barbosa ◽

Ana Celly Souza dos Santos ◽

Telma Maria AraújoMouraLemos ◽

Cleber Machado de Souza ◽

...

Keyword(s):

Comparative Analysis ◽

Genetic Factors ◽

Burning Mouth Syndrome ◽

Burning Mouth ◽

Oral Burning

Download Full-text

Burning Mouth Syndrome after Taking Clonazepam

Annals of Pharmacotherapy ◽

10.1345/aph.1z434 ◽

2001 ◽

Vol 35 (7-8) ◽

pp. 874-876 ◽

Cited By ~ 20

Author(s):

Nicole S Culhane ◽

Audrey D Hodle

Keyword(s):

Clinical Presentation ◽

Burning Mouth Syndrome ◽

Burning Sensation ◽

Anxiety And Depression ◽

Probability Scale ◽

Case Summary ◽

Published Report ◽

Underlying Causes ◽

Burning Mouth ◽

Oral Burning

OBJECTIVE: To report the first published case of clonazepam-induced burning mouth syndrome (BMS). CASE SUMMARY: A 52-year-old white woman presented to the clinic with burning mouth symptoms. The patient was previously maintained on alprazolam therapy for anxiety, but was switched to clonazepam because of increased anxiety and panic. Clonazepam significantly relieved her symptoms, but after four weeks of therapy, she reported a constant, mild, oral burning sensation. An oral examination was negative for mucosal abnormalities, and laboratory tests were unremarkable. The clonazepam dose was reduced, and the symptoms decreased, but remained intolerable. Clonazepam was discontinued, and the burning mouth symptoms completely resolved. Since no other medications relieved the anxiety and panic symptoms, the patient requested clonazepam to be reinitiated, but she again developed intolerable burning mouth symptoms. As clonazepam was discontinued, the symptoms resolved. DISCUSSION: The clinical presentation of BMS includes burning and painful sensations of the mouth in the absence of mucosal abnormalities. Candidiasis, anemia, menopause, diabetes mellitus, medications, anxiety, and depression are some causes of this syndrome. Paradoxically, clonazepam has been studied for the treatment of BMS and has demonstrated mild to moderate improvement. In this patient, underlying causes of BMS were eliminated when possible. The association between clonazepam and BMS was highly probable according to the Naranjo probability scale. CONCLUSIONS: This is the first published report describing BMS with a benzodiazepine. Although uncommon, clinicians should be aware of this potential adverse effect due to the widespread use of benzodiazepines.

Download Full-text

Burning mouth syndrome: An update

Cephalalgia Reports ◽

10.1177/2515816320970143 ◽

2020 ◽

Vol 3 ◽

pp. 251581632097014

Author(s):

Huann Lan Tan ◽

Tara Renton

Keyword(s):

Chronic Pain ◽

Orofacial Pain ◽

Salivary Flow ◽

Burning Mouth Syndrome ◽

Sensory Testing ◽

Normal Oral Mucosa ◽

Diagnosis By Exclusion ◽

Prediction And Prevention ◽

Burning Mouth ◽

Oral Burning

Background: Burning mouth syndrome (BMS) is a chronic and debilitating oral pain of the normal oral mucosa. It mainly affects women in their fifth to seventh decade. Its aetiopathogenesis remains unclear and is probably of multifactorial origin, with increasing evidence that BMS may be a neuropathic disorder. BMS is classified as an idiopathic (nociplastic) orofacial pain with or without somatosensory changes by International Classification of Orofacial Pain (ICOP 2020). The diagnosis of BMS, having excluded ‘oral burning mouth symptoms’, has evolved from basic intraoral exclusion screening to extensive clinical and laboratory investigations, which include the screening of comorbidities and other chronic pains and somatosensory testing. There is no standardised treatment in managing BMS, but a proposed combination of supportive and pharmacological treatment has been recommended. Aim: To review the current concepts of BMS definitions, classifications, aetiopathogenesis, diagnosis techniques, and evidence-based treatments in managing BMS patients. Conclusion: As BMS is a diagnosis by exclusion, thus a stratified approach is required for assessment of patients presenting BMS. A BMS diagnosis protocol is desired using a standardised screening to distinguish BMS from patient’s presenting with ‘oral burning symptoms’, and evaluation of comorbid chronic pain disorders or other medical comorbidities, which will include haematological, fungal, salivary flow, and qualitative sensory testing. Axis II and other additional quantitative sensory testing may further elucidate the causes of this condition. For future BMS prediction and prevention, will be based upon research on the relationship between other chronic pain disorders and familial history, environmental and genetic information.

Download Full-text

Burning Mouth Syndrome

Korean Journal of Otorhinolaryngology - Head and Neck Surgery ◽

10.3342/kjorl-hns.2013.56.9.550 ◽

2013 ◽

Vol 56 (9) ◽

pp. 550

Author(s):

Jae Won Chang ◽

Chul-Ho Kim

Keyword(s):

Burning Mouth Syndrome ◽

Burning Mouth

Download Full-text